Healthcare Provider Details

I. General information

NPI: 1316867179
Provider Name (Legal Business Name): MARIA MIKA GRAVIET LGMFT
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/20/2026
Last Update Date: 07/20/2026
Certification Date: 07/20/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7105 SYCAMORE AVE
TAKOMA PARK MD
20912-4634
US

IV. Provider business mailing address

2009 8TH ST NW APT 808
WASHINGTON DC
20001-5762
US

V. Phone/Fax

Practice location:
  • Phone: 202-573-7857
  • Fax:
Mailing address:
  • Phone: 202-573-7857
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License NumberLGM1216
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: